Lifewise in Central Oregon

I have been researching this procedure for quite some time now and have decided this is for me. My BMI is around 60. I don't know my BMI exactly because the scale at the doctor's office only goes up to 350. In all my research, I know that Lifewise has a written exclusion and will not under any cir****tance pay for any part of this. I called, and I cannot even see a family practicioner to ask about a diet. I have heard the only Lifewise covered people who have had this procedure have been self-pays. That is completely out of the question for me. I make too much money to qualify for OHP (if they even pay at all). My question is....is anyone dealing with Lifewise? If I could only hear one story where the outcome was (finally) favorable, I could start the process and testing. I just don't want to start, and not ever get anywhere. I am already depressed enough.

Hi Lisa, I am a LifeWise customer to had to self-pay my WLS. The decision to have WLS is not an easy one to make. It shouldn't be made more difficult by having to battle for insurance coverage for this life-saving procedure. LifeWise won my personal battle with them. I went through their appeals process to no avail. Here's what I learned at the very end of my appeals: 1) They have no intention to cover WLS. But that doesn't mean we can't make them change their minds. We still need to lodge our complaints with them and let them know they are discriminating against us. It's through our voices and our business that we can enact changes in their policies. 2) They cling to their "Exclusion Policy" for weight loss. Their exclusion policy is within their own company. They make it sound like our employers do not have weight loss treatment within their own policies. LifeWise does NOT offer treatment for weight loss to ANY of their customers. It's not the employers fault - the fault lies with LifeWise. 3) They cover anorexia, chemical dependency, and mental health issues - but NOT obesity. 4) They will not recognize obesity as a disease, even though the American Medical Association, National Institute of Health, World Health Organization, IRS, Medicare, etc. does. Because of this, they will not honor any of their "Medically Necessary" clauses. 5) They would not give me, or the House Majority Leader's office in Salem, the name of the physician in Oregon who is making the judgment call regarding WLS and its viability. Some unknown doctor is making their policies regarding obesity treatment. All they would tell me is it's a family practitioner in Oregon. 6) According to the State Insurance Division, LifeWise has opted out of the portion of their state contract that would make them honor any reversals the S.I.D. might make regarding coverage for WLS. The State Insurance Division cannot make them abide by any state rulings. LifeWise will only start covering WLS if they are made to do so by law. This would either be by a Civil Lawsuit, or through our state legislation. Many states have enacted policies within their legislation mandating insurance coverage for WLS. I've been working with others throughout Oregon to do the same. We have a yahoo group that has information regarding this - and I invite you to join us: http://groups.yahoo.com/group/Oregon_Legislation_to_Support_WLS/ I wish I had better news to give you. But I still encourage you go through the appeals process. Many people do not do this once they find out their insurance company's lack of coverage. When we don't take a stand, they don't know we're out here and we don't agree with their policy of discrimination. Eventually, LifeWise and other carriers *****fuse to cover WLS, will have to change their policies for the better. But we all need to put pressure on them to make them do the right thing. Don't give up without a fight Lisa. You owe it to yourself to fight! Tammy